Example: The total medical expense (doctor) is $200. The service date was 02/10. The bill is submitted to the client's insurance company.
On 04/01 the insurance company pays $125 to the doctor, leaving $75 as the client's responsibility. When determining if the client meets spenddown, consider the bill as incurred on 02/10 and the billing date as 04/01. Allow $75 towards spenddown.
For renal/hemo dialysis charges the provider must provide:
For inpatient hospital charges, accept as proof the hospital's written estimate of the amount that a Medicare and/or non-Medicare TPL resource is expected to pay towards a person's medical care costs.
Hospitals may provide a written estimate of the client's liability for medical costs directly to the FCRC.
The statement must show monthly liability incurred by an enrolled client. When this occurs make a determination if spenddown has been met.
Illinois Department of Human ServicesJB Pritzker, Governor · Dulce Quintero, Secretary
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